Eyelid reduction (blepharoplasty)

The eyes are the most important feature on the face. They are always the first thing looked at by others. Their beauty can be obscured by excess skin causing hoods over the upper lids or prominent folds in the lower lids. Excess fat can also give the appearance of puffiness and bags. Unflattering light casts shadows giving the appearance of dark rings. All these factors make you look tired, older, stern and less approachable.

When these problems are corrected by a ‘blepharoplasty’, the results can be dramatic. However, it is usual for others not to notice that you have had an operation. More commonly they will comment on how well you look.

The normal ageing process includes stretching of the eyelid skin, which in this area is very thin. Fine lines and creases develop due to the activity of facial muscles in smiling and squinting. Exposure to sunlight and smoking are other factors in premature ageing and some people have an inherited tendency for their skin to age more quickly than others. Excess fat deposits around the eyes are another inherited characteristic and with age these move forward and drop downwards to become more obvious.

Eyelid reduction: Frequently asked questions

What results can I expect?Results following blepharoplasty are usually dramatic. However, it is important to consider some points and avoid unrealistic expectations.

Dark rings under the eyes caused by skin pigmentation on the lower eyelid skin will not be changed even though all excess skin and fat has gone and the smooth contour restored.

Fine eyelid skin creases will not be eradicated. The quality of the skin is not changed by an operation but simply it’s position and any tension.

Trying to over correct skin tension would produce a staring appearance and potentially a change in the shape of the eye. This is especially true of the lower eyeid and particular care must be taken.

If this is a risk on the lower eyelid it may be necessary to do the operation using an incision inside the eyelid. This is called the ‘transconjunctival approach’.

The crow’s feet cannot be completely eradicated either but are improved a great deal.

Secondary eye bags (fullness below the lower eyelid on the cheek bone) are not corrected by this procedure. They can only be removed by leaving a fine scar and it follows that the problem must be severe in order to justify this.

What happens during the eyelid reduction operation?Blepharoplasty is usually carried out under general anaesthetic followed by a one night stay in hospital.

The incision for the upper eyelid is in the natural crease line approximately 10mm above the eyelashes and extends out into the ‘crow’s foot’ area. Excess skin and muscle, which forms the hood, is removed.

If necessary, fat may be removed to further shape the upper eyelid crease. Fat can be taken from the inner aspect of the upper eyelid where it abuts the bridge of the nose. Excess fat can also be present at the outer part of the upper eyelid and above this area near to the eyebrow. When this is done the upper lid incision is closed using one continuous stitch which runs from end to end of the incision line.

The incision for the lower eyelid is just below the eyelashes. It passes across to just beyond the corner of the eye. A skin and muscle layer is hinged forward and any excess fat underneath is removed. The skin is then lifted upwards, but without tension, and any overlapping skin excess is removed. Very fine stitches are used to close this wound.

When the lower eyelid is too loose it is necessary to make an incision inside the lower eyelid instead of at the front. This is the ‘transconjuntival approach’. Fat is removed from behind the lower eyelid which will then simply return to a normal contour without the previous bulge. The inside of the lower eyelid heals without needing stitches.

At the end of the operation ointment is applied to the eyelids. This contains antibiotic to prevent infection and a steroid which is anti-inflammatory to decrease swelling.

A wetted gauze dressing is then draped over the eyes. This is soothing and provides gentle pressure to keep the eyelids closed and prevent movement. Movement might create bleeding and unwanted bruising along the incision line.

What long does it take to recover after eyelid reduction surgery?Immediately after the operation you will need to rest in bed. Antibiotic and anti-inflammatory ointment will be applied to the eyelid skin and your eyes will be covered with the soothing dressing of wet gauze.You will experience mild swelling and bruising. You many have slight discomfort which can be controlled with a simple pain killer such as paracetamol.

Lower eyelid stitches are usually dissolving so this is left alone to heal as a very fine line. The upper eyelid stitch will be removed one week after surgery. The stitch runs from end to end. So it’s a simple matter cutting the inner end and pulling the outer end whilst applying firm pressure along the eyelid so that it isn’t distorted or sore.

Most of the swelling will subside in the first week, but bruising may persist into the second week. You might want to wear a pair of dark glasses during this time. We will show you how to gently clean your eyes and apply antibiotic ointment.

Will I have scars afterwards?Scar lines will be pink for a few weeks and will then fade to become almost invisible. Occasionally, in very fair skinned people, this takes longer. You can start to apply make up from the second week, but this may take longer as the lashes may still be numb and too much make up, especially eyeliner, may be irritating and make your eyes water. The scars in the ‘crow’s feet’ area become lumpy for a while, but they always flatten with time.

Your surgeon will make the incisions along the natural creases in the eye socket and just below the lash line so the scars will be hidden.

Is there any danger to my sight?When operating close to the eyeball, blindness is a theoretical possibility but an extreme rarity. Your surgeon is very experienced and will discuss with you any risks of complications.

Complications following blepharoplasty are rare. Infection is very rare. Antibiotic ointment is used on the stitch lines and oral antibiotics are provided for two days. Bleeding may cause more bruising, but will not change the final outcome. Bleeding during surgery is of course completely controlled. So it’s only excessive movement after surgery which can cause problems such as watery or scratchy eyes. Hence the need for complete rest after the procedure.

Who will carry out the procedure?As well as our cosmetic surgeons, this procedure is also performed by Consultant Ophthalmologist Mr Ian Subak-Sharpe who specialises in plastic surgery of the eyelid and brow.

Please note if you choose an ophthalmic surgeon their prices may differ from our guide prices but typically include an examination of your eyesight and health as well.